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      Insight to changing morphologic patterns of glomerulopathy in adult Pakistani patients: an institutional perspective


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          Idiopathic nephrotic syndrome encompasses diverse histogenetic patterns and depicts socioeconomic and demographic differences attributable to genetic profile, environmental factors and prevalence of infectious diseases. A lack of renal registry in our country necessitates a need to document changing histologic patterns of nephrotic syndrome as noted in different parts of the world.


          We retrospectively analyzed 140 patients who underwent renal biopsy at Liaquat National Hospital from January 2009 to December 2013 over a period of 3 years. On the basis of clinical profile cases were segregated into nephritic and nephrotic syndrome and histologic and immunoflourescence findings were analyzed.


          Among 140 cases of glomerulonephritis diagnosed in the study period, 98 cases (70 %) were those of primary glomerulonephritis and 42 were of secondary glomerulopathy (30 %). Membranous glomerulonephritis was the most common primary glomerulonephritis (33.6 %) followed by focal segmental glomerulosclerosis FSGS (20.4 %), whereas lupus nephritis is the most common secondary glomerulopathy (47.6 %) followed by amyloidosis and diabetic glomerulosclerosis (16.6 % each).


          We found a considerable high incidence of membranous glomerulonephritis and FSGS in our population that entails a need to investigate prevalence of associated factors like Hepatitis B and HIV infections in population at risk. Moreover, renal biopsy registry would be instrumental in this regard to record changing disease pattern in this part of the world.

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          Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997.

          Data compiled during the 1970s and early 1980s indicated that during these periods, membranous nephropathy was the most common cause of unexplained nephrotic syndrome in adults, followed in order of frequency by minimal-change nephropathy and focal segmental glomerulosclerosis (FSGS). However, we and others recently reported an increase in the incidence of FSGS over the past two decades, and the number of cases of FSGS diagnosed by renal biopsies in these centers now exceeds the number of cases of membranous nephropathy. Nonetheless, as a substantial fraction of patients with FSGS do not have the nephrotic syndrome, it remained unclear as to what extent the relative frequencies of FSGS and other glomerulopathies as causes of the nephrotic syndrome have changed over this time. To address this concern, we reviewed data from 1,000 adult native kidney biopsies performed between January 1976 and April 1979 and from 1,000 biopsies performed between January 1995 and January 1997, identified all cases with a full-blown nephrotic syndrome of unknown etiology at the time of biopsy, and compared the relative frequencies with which specific diseases were diagnosed in these latter cases between the two time intervals. The main findings of this study were that, first, during the 1976 to 1979 period, the relative frequencies of membranous (36%) and minimal-change (23%) nephropathies and of FSGS (15%) as causes of unexplained nephrotic syndrome were similar to those observed in previous studies during the 1970s and early 1980s. In contrast, from 1995 to 1997, FSGS was the most common cause of this syndrome, accounting for 35% of cases compared with 33% for membranous nephropathy. Second, during the 1995 to 1997 period, FSGS accounted for more than 50% of cases of unexplained nephrotic syndrome in black adults and for 67% of such cases in black adults younger than 45 years. Third, although the relative frequency of nephrotic syndrome due to FSGS was two to three times higher in black than in white patients during both study periods, the frequency of FSGS increased similarly among both racial groups from the earlier to the later period. Fourth, the frequency of minimal-change nephrotic syndrome decreased from the earlier to the later study period in both black and white adults. Fifth, the relative frequency of membranoproliferative glomerulonephritis as a cause of the nephrotic syndrome declined from the 1976 to 1979 period to the 1995 to 1997 period, whereas that of immunoglobulin A nephropathy appeared to increase; the latter accounted for 14% of cases of unexplained nephrotic syndrome in white adults during the latter study period. Finally, 10% of nephrotic adults older than 44 years had AL amyloid nephropathy; none of these patients had multiple myeloma or a known paraprotein at the time of renal biopsy.
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            Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience.

            The prevalence of glomerular diseases differs according to geographic area, race, age and indications for a renal biopsy. This study was conducted to evaluate the distribution and changing patterns of renal diseases during the past 20 years in a large patient population in Korea. Patients aged 16 years or older who underwent a renal biopsy at Severance Hospital in the Yonsei University Health System from 1987 to 2006 were enrolled. All medical records were reviewed retrospectively. In total, 1818 patients (M:F = 1.02:1) were reviewed. Glomerulonephritis (GN) comprised 85.9% of the total biopsied cases. The most common primary GN was IgA nephropathy (IgAN) (28.3%), which was followed by minimal change disease (MCD) (15.5%), membranous nephropathy (MN) (12.3%), focal segmental glomerulosclerosis (FSGS) (5.6%) and membranoproliferative GN (MPGN) (4.0%). The most common secondary GN was lupus nephritis (8.7%). The most common idiopathic nephrotic syndrome was MCD (38.5%), which was followed by MN and IgAN. Among 128 (7.4%) patients who were HBsAg-positive, MN (30.5%) and MPGN (21.1%) were the most common GN. When the incidence rates between 1987-91 and 2002-06 were compared, IgAN increased from 25.6 to 34.5%, while MCD (from 23.2 to 7.0%) and MPGN (from 6.7 to 1.7%) decreased significantly (P < 0.01). IgAN was the most common primary GN, and MCD was the most common cause of nephrotic syndrome. In the 5-year quartile comparison, the relative frequency of IgAN increased, while the relative frequency of MCD and MPGN decreased significantly during the past 20 years.
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              Clinicopathologic correlations of renal pathology in Spain.

              There are not enough large epidemiologic population-based studies of biopsy-proven nephropathies with detailed clinicopathologic correlations. The Glomerulonephritis Registry of the Spanish Society of Nephrology has obtained data from 9378 cases with native biopsy-proven renal diseases and well-known clinical syndrome between 1994 and 2001, investigating clinicopathologic correlations. Patients were divided in three groups according to age: children ( 65 years). The most common clinical syndrome at any age is nephrotic syndrome (35.5%), followed by asymptomatic urinary abnormalities (25.9%), acute renal failure (12.9%), chronic renal failure (12.1%), nephritic syndrome (4.5%), macroscopic haematuria (4.5%), and arterial hypertension (3.0%). A male predominance is observed at any age (3:2). The frequencies of histologic findings are statistically different in all syndromes according to age. Minimal change disease is the most frequent finding in children with nephrotic syndrome (39.5%), whereas in adults and elderly, membranous nephropathy is the most prevalent (24.2% and 28.0%, respectively). Ig A nephropathy (IgAN) is the most frequent glomerulonephritis in patients with asymptomatic urinary abnormalities at any age. Acute renal failure is an important cause for performing a kidney biopsy in elderly and vasculitis is the main histologic finding. The clinical manifestations of focal segmental glomerulosclerosis, non-IgA mesangial nephropathy, lupus nephritis, vasculitis, and nephroangiosclerosis are statistically different according to age. The findings of clinicopathologic correlations obtained from the Spanish Registry of Glomerulonephritis on native biopsy-proven renal diseases add valuable information to previous reports and it can be the initial step for follow-up and prospective studies.

                Author and article information

                BMC Res Notes
                BMC Res Notes
                BMC Research Notes
                BioMed Central (London )
                8 February 2016
                8 February 2016
                : 9
                : 73
                [ ]Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
                [ ]Liaquat National Hospital and Medical College, Karachi, Pakistan
                [ ]Dhaka Medical College, Dhaka, Bangladesh
                © Hashmi et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                : 12 March 2015
                : 19 January 2016
                Research Article
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                © The Author(s) 2016

                nephrotic syndrome,renal biopsy,membranous glomerulonephritis,focal segmental glomerulosclerosis


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